刚果民主共和国万加福音医院糖尿病患者血糖控制不佳的流行状况及决定因素。
Prevalence and determinants of poor glycaemic control amongst patients with diabetes followed at Vanga Evangelical Hospital, Democratic Republic of the Congo.
机构信息
Department of Family Medicine, Faculty of Medicine, Protestant University of Congo, Kinshasa.
出版信息
Afr J Prim Health Care Fam Med. 2021 Apr 30;13(1):e1-e6. doi: 10.4102/phcfm.v13i1.2664.
BACKGROUND
The prevalence of diabetes mellitus is increasing dramatically in developing countries, where diabetic patients usually present with poor glycaemic control, leading to complications and worsening the prognosis.
AIM
The aim of this study was to determine the extent of poor glycaemic control and its determinants in diabetic patients.
SETTING
The study was conducted in a rural area of the province of Kwilu, Democratic Republic of the Congo.
METHODS
This research comprised a cross-sectional study involving 300 Type 1 and 2 diabetic patients attending Vanga Evangelical Hospital in the Democratic Republic of the Congo from January 2018 to March 2018. Patients' sociodemographic, clinical and biological characteristics, accessibility to the health structure and treatment were described. The determinants of poor glycaemic control were identified using multivariate logistic regression at the p 0.05 level of statistical significance.
RESULTS
The mean age of participants was 46.9 ± 16.3 years, 68.4% were men, and 62.3% had Type 2 diabetes mellitus. Poor glycaemic control was present in 78% of patients. The independent determinants of poor glycaemic control were tobacco use (adjusted odds ratio [aOR]: 2.01 [1.77-5.20], p = 0.015), the presence of comorbidities (aOR: 2.86 [1.95-6.65], p = 0.007), the presence of a factor contributing to hyperglycaemia (aOR: 2.74 [1.83-3.67], p = 0.014), missing scheduled appointments (aOR: 2.59 [1.94-7.13], p = 0.006) and non-adherence to treatment (aOR: 4.09 [1.35-6.39], p = 0.008).
CONCLUSION
This study shows that more than three-quarters of diabetics undergoing treatment are not controlled, with mainly patient-related factors as the main explanatory factors for this poor glycaemic control. Therefore, the establishment of a therapeutic education programme and wider integration of diabetes care services, mainly at the primary level of the healthcare pyramid, should contribute to improved diabetes treatment.
背景
在发展中国家，糖尿病的患病率正在急剧上升，这些国家的糖尿病患者通常血糖控制不佳，导致并发症发生，预后恶化。
目的
本研究旨在确定糖尿病患者血糖控制不佳的程度及其决定因素。
设置
本研究在刚果民主共和国夸卢省的一个农村地区进行。
方法
这是一项横断面研究，纳入了 2018 年 1 月至 2018 年 3 月期间在刚果民主共和国万加福音医院就诊的 300 例 1 型和 2 型糖尿病患者。描述了患者的社会人口学、临床和生物学特征、获得卫生结构和治疗的情况。采用多变量 logistic 回归分析确定血糖控制不佳的决定因素，统计显著性水平为 p < 0.05。
结果
参与者的平均年龄为 46.9 ± 16.3 岁，68.4%为男性，62.3%患有 2 型糖尿病。78%的患者血糖控制不佳。血糖控制不佳的独立决定因素是吸烟（调整后的优势比 [aOR]：2.01 [1.77-5.20]，p = 0.015）、合并症（aOR：2.86 [1.95-6.65]，p = 0.007）、存在导致高血糖的因素（aOR：2.74 [1.83-3.67]，p = 0.014）、未按计划就诊（aOR：2.59 [1.94-7.13]，p = 0.006）和不遵医嘱（aOR：4.09 [1.35-6.39]，p = 0.008）。
结论
本研究表明，接受治疗的糖尿病患者中，超过四分之三血糖控制不佳，主要是患者相关因素是血糖控制不佳的主要解释因素。因此，建立治疗教育计划和更广泛地整合糖尿病护理服务，主要是在医疗保健金字塔的初级保健层面，应有助于改善糖尿病治疗。
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